How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines

Table 2 The generic recommendations and their use in the knowledge bases.

#	Generic recommendations	Hyp.	Diab.	Dys.	Tob.	Atr.	Thr.	Exceptions
1	If the current treatment is effective, well-tolerated and recommended by the CPG, it should be continued	●	●	●	○	●	○	12/113
2	If the current treatment is ineffective, the dose can be increased	◐	●	●	◐	●	●	2/113
3	If the current treatment is too effective, the dose can be decreased	●	●	n.a.	n.a.	n.a.	●	0/113
4	If a drug of the current treatment is poorly tolerated, the dose can be decreased	●	●	●	◐	●	●	1/43
5	If a treatment was not effective in the recent past, it should not be prescribed again	●	●	●	○	●	○	15/113
6	If a drug was not tolerated in the past, it should not be prescribed again	●	●	●	●	●	●	0/43
7	If a treatment is both poorly tolerated and ineffective, apply the recommendations for poor tolerance	●	●	●	●	●	●	0/113
8	Two drugs of the same pharmaco-therapeutic class should not be prescribed in association	●	◐	●	◐	●	●	6/43

Hyp.: hypertension, Diab.: type 2 diabetes, Dys.: dyslipaemia, Tob.: tobacco addiction, Atr.: atrial fibrillation, Thr.: thrombo-embolic risk. ● indicates that the recommendation is used for implementing the CPG, ◐ that the recommendation is used with exceptions, ○ that the recommendation does not apply, and n.a. that the situation does not occur in practice. The exception column gives the rate of exceptions for each generic recommendations (number of exceptions/denominator; the denominator is either 43, the total number of drug classes, or 113, the total number of recommended treatments found in the five guidelines).

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